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Q. My husband has dysphagia, which makes going to a...

Q. My husband has dysphagia, which makes going to a restaurant very difficult. His first few bites of food will not go down and it makes him choke.

A. Choking on food, as you describe, can be embarrassing at a restaurant. But his problem may be dangerous all the time.

Dysphagia is the medical term for difficult swallowing. It can be caused by many factors, some of which are physical and some emotional. To help him, it's important to determine the cause.

One of the most common causes is simply that a person doesn't chew food enough and tries to swallow too much at once. This may occur more often in stressful situations. It's easy to check this out, but sometimes it's a habit that's hard to break.

Physically, swallowing is divided into two parts. The first part (oropharyngeal) is getting the food from the opening of the mouth to the opening of the esophagus at the back of the throat. The second part is moving the food through the esophagus into the stomach.

Oropharyngeal problems are characterized by choking, coughing and regurgitation, immediately after starting to swallow. Paradoxically, it's often easier to swallow soft foods than fluids.

A number of nerve and muscle disorders diminish or prevent movement of food to the back of the throat, including multiple sclerosis and myasthenia gravis. Difficulty speaking and hoarseness also may be present.

But immediate choking and coughing up food also may indicate a psychological response to the fear of swallowing. This may be caused by nausea, pain in the esophagus and eating disorders. If your husband's problem occurs only in a restaurant, it points more to an emotional issue playing a large role.

The esophagus may have a mechanical obstruction, or the muscles in the walls of the esophagus may be malfunctioning. Obstructions typically block solids more than liquids, but muscle disorders cause equally difficult swallowing for both.

I am concerned because, if he continues to have dysphagia, he has an increased risk of having food block his windpipe. So please have this problem evaluated by a physician and immediately learn how to perform the Heimlich maneuver.

As with any time you are going to see a doctor, remember that the medical history you provide is the most important part of making a diagnosis. So write down all you can think of, with particular reference to when and where his symptoms occur, how long they last, what makes the problem better and what makes it worse.

Update on communicating: The gap between

what the patient wants to know and what the doctor is saying is a cause for concern for patients and doctors alike.

An article in the journal Behavioral Medicine points out that about half of the people studied with cancer said they were not fully informed about their diagnosis, treatment and expected outcomes. In another study, 75 percent of patients said their doctors create undue worry by not providing them with sufficient information.

Health professionals obviously think that breaking bad news is an important part of their job, but the researchers indicate that many "feel inadequately trained to do it effectively."

Researchers also report that some physicians think hearing bad news can harm a person's health, though evidence shows it's not true for most people. But analysis of research is based on averages. And many patients and physicians are different from the average.

To ensure that you get the type and amount of information you want about a major medical problem, it's up to you to tell your doctor and other health-care professionals what you think is best for you.